Put Time On Your Side

Poets and songwriters have penned verses about it. Politicians have spoken of its fleeting nature and its inevitable march forward. You can't save it, buy it, or borrow it; you can't replace it, and it seems there's never enough of it. Physicians and their staff often race through each day trying to make the most of this precious commodity.

Time may seem uncontrollable, but in truth there are ways to manage our time better. Here are some time management tips that I've seen work in medical practices, and that, with a little effort, you can put to work for yourself.
 
Start on time, stay on time

To keep time from getting away from you, it's crucial that you have a realistic schedule that is customized to your needs and work habits. I've seen too many physicians whose schedules have them seeing patients at 8:30 a.m. -- when in reality, they rarely get into the office before 8:40. They play catch-up all day and never get out of the office when they planned. When they finally do leave, there's a mound of paperwork on the desk to deal with tomorrow, making it even more difficult to get a handle on the next day's schedule.

To really see how your schedule affects your time, examine your work patterns using a patient activity time study to document how much time is spent on each step of the patient's visit. This can help you find where delays in patient flow are happening --  In the waiting room? In the exam room? --  and uncover why activities are postponed that might otherwise be completed in real time.

Working in real time means doing today's work today. For example, allow sufficient time in the schedule to document or dictate chart notes and complete charge tickets as you go, rather than stacking charts to deal with dictation at the end of the day.

Some physicians use the so-called "fourth exam room" approach. They simply see three patients in a row, then use the fourth time slot to catch up on paperwork related to those patients.

Your staff must be committed to consistently completing the documentation for the time study, recording all the activities that have an effect on the schedule. When they realize the effort is geared to improving the flow of activity, they should have no problem incorporating it into their day. The key is to keep it simple, review the process at the end of the first day to be sure everyone is filling out the information completely, and remind everyone at the beginning of each day. Be sure to thank staff for helping with the project.

Once you've tracked your time utilization patterns for one week, it will be easy for you to develop a realistic schedule that is compatible with your style and patient needs. This holds true whether your schedule is traditional, modified, or open-access.

Use space and tools wisely

Take a critical look at the resources you have and how you use them. Ask yourself some basic questions about the design and function of your facility and you are likely to discover many time-robbers.

Is the general clinical space efficiently laid out and used? The exam rooms and the nurse's station should be in close proximity to allow for easy flow and minimal steps. If your private office is not within a stone's throw of this hub of activity, you will want to set up a workstation in this part of the office. This will allow you to do essential activities between patients, such as charting and making phone calls. If it takes three minutes to walk to and from your private office and you do this 10 times a day, you've lost a half hour every day.

Are the exam rooms physician-ready? This means when you go to see the patient, all equipment is working properly, supplies are well stocked, and the chart has been prepared before the visit. Your nurse has anticipated your needs so you will not need to leave the exam room until the patient visit is complete. If you do find you need something during the visit, use a signaling system to call for help rather than going out in the hallway to look for your nurse or medical assistant.

At a time when profits are shrinking, physicians are often reluctant to purchase new equipment for the office. But there are scores of worthwhile time-saving devices that reduce errors, improve performance, and allow you to spend your time more wisely. One example is using automated telephone systems for appointment reminders, obtaining lab results, and providing "on-hold" patient information and patient education messages. You'll notice significant savings in time, improved performance, and profitability over time when you ramp up your office's phone capabilities.

Certainly the addition of an EMR is a boon to any medical practice, particularly since it can mine clinical data. For example, should you need to recall patients with a specific condition or who are taking a particular medication, the EMR can sort and retrieve the data quickly and accurately. To do this manually would be time-consuming and extremely costly. An essential element to maximizing the success of your EMR is adding terminals at each workstation so staff can have simultaneous access to files, and providing physicians with a personal digital assistant (PDA) so they can retrieve information on the run.

Delegate, delegate

I frequently discover during practice site visits that the physicians are taking on many tasks that should ideally be delegated to the office manager or other staff. Why do physicians do this? Here are a few reasons that come to mind: 

• You don't think staff can do things as well as you can. 
• You think assigning someone else the task takes too much effort.
• You want things done your way.
• You are accustomed to doing things for yourself.

If you are caught up in these reasons and are performing office tasks that don't require a physician's level of expertise, it's time to start delegating.

Identify the tasks you don't need to do and find the right person to assign the task to. A good rule of thumb? If a staff member can do a task 80 percent as well as you can, delegate it. In addition to saving your own time, delegating is an expression of confidence in your staff. It strengthens their skills and is a source of job enrichment and fulfillment that helps improve teamwork.

Communicate well

Physicians need to be a part of the office team and not rely on their manager to do all the communicating. But then again, how much time do you have to get your message out, and what are the most effective ways to do it? 

Certainly one-on-one meetings work when you're dealing with a high-priority or sensitive item that needs attention. But sometimes it's better to communicate to a group because everyone hears the same, consistent message, and can give instant feedback. 

Regular meetings will help you gain an understanding of each staff member's contribution to the practice. Meetings are also an opportunity for you to share your vision for the practice and discuss what you would like to accomplish. When the staff understands where you want to go, they will find a way to help you get there. Be sure to establish clear meeting objectives and set time parameters to keep meetings from turning into time-wasters.

Morning huddles are a great way to communicate informally to a group and will help you and your staff plan each day. Take five minutes before you begin seeing patients; review the schedule with the staff and discuss factors that may affect your ability to stay on schedule. Together, design a game plan to resolve potential problems.

Intra- and interoffice e-mail and instant messaging are excellent tools that help you communicate in real time and with documentation of your "discussion." Just as important, it allows you to communicate when it is convenient for you, eliminating interruptions.

It's a good idea to provide your staff with guidelines for effective, appropriate use of electronic forms of communication, such as:

• Keep the message short and specific.
• Maintain a professional tone.
• Do not use electronic communication to discuss sensitive or complicated topics.
• Do not use electronic communication to avoid open dialogue or confrontation.
• Don't write something you aren't willing to see in print.
• Keep the messages work-related.

For more information on e-mail guidelines for staff, read "Stifle Staff Web Abuse" by Joan Szabo at
www.PhysiciansPractice.com using the Search by Author function.

Success is up to you

Managing time requires self-discipline, planning, and personal structure. The daily "to do" list is a good starting point for setting goals, prioritizing the many things that need your attention, and determining what you can realistically accomplish in a day. When you take the time to plan your activities, you actually have more time for them, and you will learn to be flexible to changing priorities. 

Making lists to manage your time has never been easier. It can be a simple matter of marking a paper calendar or planner, or using electronic help aids, such as Microsoft Outlook, that will send a pop-up reminder to your computer screen or PDA. But there isn't any system that will work unless you are committed to managing and controlling your time.

It's up to you to determine when unscheduled visitors, phone calls, or meetings should be postponed or eliminated. No one knows the demands on your time better than you do, and no one else is in a better place to manage those demands.

In reality, time management is self management. Your success depends on commitment to building time management techniques into your daily routine. Once you do, you will be amazed at what you can achieve in a day and the time you gain for the personal pursuits you just haven't been able to get to.

Judy Capko is principal of Capko & Co.,
a healthcare consulting firm based in
Thousand Oaks, Calif. (www.capko.com).
She can be reached at JudyCapko@aol.com
or editor@physicianspractice.com.

This article originally appeared in the February 2005 issue of Physicians Practice.